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The Mental Health Disorder Caused By Incest And Child Abuse

It’s the disorder that robs people of their ability to feel whole.

When it comes to the disorder that can splinter people into discrete and fractious personalities, it’s important to note that this complex disorder is not uncommon.

Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, is often misdiagnosed. For the sufferer, the experience can be deeply confusing, with a distorted sense of self and long periods of time lost to dissociation.

Caused by childhood abuse, incest and neglect, the disorder often develops as a coping mechanism. It allows young kids to compartmentalize abuse so they can survive when caregivers or family members make them feel unsafe.

DID is described as a complex form of post-traumatic stress and dissociation, which causes a discontinuity in one’s self of self.

Professor Warwick Middleton is a leader in research and treatment on the disorder and has been working in the field for decades. Speaking to News.com.au, he recalls first writing a paper on the condition in 1991.

DID can be categorized as a developmental disorder, where a person’s personality fails to integrate as they develop.

It’s defined as an “identity disruption” and you may know it as “multiple personality disorder.” In some cultures, it may be identified as spiritual or demonic possession.

How do you identify dissociative identity disorder?

They have symptoms that you might have seen depicted in movies like “Sybil” or TV shows like “The United States of Tara.”

Sufferers of the disorder have a complex system of dissociation, which Middleton describes as “splitting off at different times into different identity states.”

“The individual might experience this as internal or external voices, which may argue and which may be associated with particular behaviors. Alternative handwritings. A whole spectrum of things,” he said.

What Middleton describes is a form of dissociation where the sufferer splits off into what appears to be a completely different “personalities.” Sufferers usually have at least two distinct personalities at some point in their life, some may have many more.

Middleton says that the majority of sufferers also fulfill criteria for post-traumatic stress disorder, major depression and somatization, while many of them have eating disorders and social phobias.

“Typically they present in their thirties, having bounced around the system for quite a while,” he said. “Because they hear voices … they’re given antipsychotics. From our research, about 20 percent of them are diagnosed with bipolar disorder.”

“If you look a bit closer they don’t have bipolar. That was just someone identifying them switching between different personality states.”

Losing large periods of your life

People who suffer from DID often have trouble remembering things.

In the autobiographical memory of their life, there are gaps where they have no recollection of what happened or what they did — and not in a regularly reported way, like when you drive home and arrive at your door with little recall of your journey.

It’s about losing big parts of your life to your other “personalities” who take over, commandeering your consciousness. While it might sound like the stuff of movies, the disorder is very real.

From Middleton’s research, he suggests it occurs in about 1.1 percent of the adult population. He describes this as being a “relatively common” condition.

What are people with DID like?

“(People with DID) range in a spectrum — (there) are people who sort of live on the fringes of existence who are chronically mentally ill, bouncing around services to people who are very high achieving, who may work in mental health services themselves.”

Sufferers often report weeks or months of their life passing by them where they have no memory and feel no agency over what transpired in that period.”

In the early nineties, the disorder was not often diagnosed and hardly at all identified by mental health professionals. These days it is much more commonly diagnosed.

Treatment for the disorder

Middleton says his interest in the disorder developed because there was “very little clinical awareness” and it wasn’t a diagnosis routinely made.

The other problem was that the issue of family assault and “incest” wasn’t properly acknowledged within Australia, where he is based, at the time.

“We now know that incest is, unfortunately, very common,” Middleton said.

“Basically in every country in the world where systematic research is done into childhood trauma and the presence of dissociative disorders we get very similar patterns.”

He said with standard treatment like cognitive behavioral therapy, the outcomes are very poor for sufferers of this disorder.

Treatment options with good outcomes include phase-orientated treatment.

Middleton was the first person, along with his colleague Dr. Jeremy Butts to publish research linking childhood trauma with the presence of DID. This paper was published over 20 years ago in the Australian and New Zealand Journal of Psychiatry.

He’s been a long-term director of the Society for Trauma and Dissociation.

Their findings showed that across the world, almost all sufferers of DID had, during childhood, suffered from some form of abuse, be it physical, sexual or neglect.

For more information on CPTSD and other issues visit our YouTube Channel

If you need support or would like to connect with like-minded people join our Private and Closed online Facebook Group for Child Abuse Survivors and those with CPTSD. Click here to join

The Memoir You Will Bear Witness is available on Amazon in Kindle and Paperback

Retrieved https://youwillbearwitness.com/2019/04/09/the-mental-health-disorder-caused-by-incest-and-child-abuse-2/

Returning to Toxic Relationships-part-1

Almost all of us have, at some time or other, run into an old flame and felt the desire to reconnect.  What draws us is a mix of nostalgia and the desire to correct past mistakes, to “get it right” this time.

The problem is that many of the former relationships to which we find ourselves drawn as abuse survivors were, to put it mildly, toxic.

Why do we save the love letters of a man who repeatedly cheated on us?  Why are we tempted to call the boyfriend who stole our charge cards and emptied our bank account?  Why do we find ourselves checking Facebook for the ex who put us in the emergency room?

The answer is not that time heals all wounds.  It is not that we are seeking closure, that we enjoy pain…or that we are simply too dim to know better.

One reason is familiarity.  There is something powerfully familiar about these toxic relationships.  They evoke buried memories from our past, memories we once associated with love.

Such memories are not generally in the forefront of our consciousness.  But a woman whose father was sharp and impatient with her as a child is likely to choose a partner with the same shortcomings.  A man whose mother was elusive and unresponsive is likely to find women with those qualities attractive.

The more closely an adult relationship mirrors the abuse we experienced in childhood, the more emotional power that relationship will hold for us.  And the more appealing that partner will seem.  It is as if we are wrestling with an irresistible force.

That force is not, however, love.

This series will continue next week.

FOR MORE OF MY ARTICLES ON POVERTY, POLITICS, AND MATTERS OF CONSCIENCE CHECK OUT MY BLOG A LAWYER’S PRAYERS AT: https://alawyersprayers.com

Retreieved: https://avoicereclaimed.com/2019/02/24/returning-to-toxic-relationships-part-1/

The plot thickens …

Having re-watched a favourite TV Series (Da Vinci Demons), attention was drawn to something that’s now screaming out louder and loader. Despite the appalling deception, tomfoolery & murders committed in the times of Leonardo Da Vinci (15th Cen.) in this staged re-enactment, the common powers possessed by the Catholic Church was always taken for granted. Social dynamics included a default framework of the church’s primary inclusion in the basic ecosystem. Australia’s recent mis-focus on Captain Cook, ahead of Captain Flinders & Bungaree. Each summarises how History has been remembered, not genuinely proven.

Australia’s Royal Commission into Institutional Responses to Child Sexual Abuse had been the Initial national confrontation, followed by numerous other global countries addressing this common issue. Catholic Vatican’s Pope (Francis) has at least begun publicly addressing this issue, after Millenia of denials-hiding evidence-moving wrongdoers & almost a century of rewritten Papal Orders advocating sins being hidden. As mammoth an issue this is, what’s becoming apparent is the immensity of addressing it. The lives of these children is paramount, as is the resulting residual impacts these Sexual Abuses has had. Postings such as these help share some of these factual truths.

As numerous bodies of Surviving Victims, Medical, Commercial & Community bodies provide help, News reports in the Journalism of individual to broad scale cases & each country offering their own nuances of interpreting & reacting to these ordeals – the immensity of this understanding also risks being ‘swept under the carpet‘ as CSA had been, to grow to what it had. Together, we need to openly address this publicly, openly, transparently & suitably as possible. Groups such as this RoyalCommBBC are only getting started on our mission & via your simply sharing these posts about your contacts – another Survivour may remember things & get suitable help, pictures may remind a family of an unsolved mystery or News of someone being caught out for inappropriate behaviour triggers off flashbacks leading to arrest. We hope this helps out open up our lives.

Redress: the setting right of that which is morally wrong

August 9, 2018. Anne

Through the Redress Scheme, those who have been sexually abused in Australian institutions now have the opportunity to obtain financial compensation, counselling and a personal apology for the horror they endured. But don’t for one minute think it will be an easy process.

On 14 September 2015 the Australian Royal Commission into Institutional Responses to Child Sexual Abuse released its Redress and Civil Litigation Report. After receiving submissions from more than 250 individuals and institutions, the 589-page report made 99 recommendations. There was an enormous financial cost to the Australian public for the Royal Commission so we should listen to what the Royal Commission had to say.

Here are some of the most significant recommendations regarding the Redress Scheme and what’s happened so far:

A national redress scheme for the estimated 60,000 likely claimants be established and commence accepting applications from survivors no later than 1 July 2017.

The Redress Scheme started on 1 July 2018, just a year late.  While everyone can start the application process, my understanding is that some State legislation needs to catch up. Applications from Queensland, South Australia, Tasmania and Western Australia can be received but they can’t yet be assessed.

The major perpetrators of institutional child sexual abuse (the Catholic, Anglican and Uniting churches, Salvation Army, Scouts and YMCA) have agreed to join the scheme.  However, the current lack of legislation in some States creates a loophole, so let’s hope those non-government institutions don’t use it to opt out.

The redress scheme to be independent of the offending institutions.

The applications for redress will be assessed by Independent Decision Makers, but we don’t know who they are. The Redress Scheme assures applicants that the Independent Decision Makers have no connection with participating institutions.  Does this mean there will be no Catholic, Anglican or Uniting Church parishioners?  No ex or current members of the Salvation Army, Scouts or the YMCA?  How can the assessment process be transparent if the Independent Decision Makers are not named?

Appropriate redress for survivors would include a financial payment up to $200,000.

The payment through the National Redress Scheme has been reduced to a maximum of $150,000.

$150,000 is a paltry amount for the impact of child sexual abuse on your life.  It would go nowhere near compensating Ms Forgotten Australian for her lack of ability to sustain full-time employment throughout her life, without taking into account her suffering.  The average redress payment is expected to be $76,000 and many will get less than that.

Applicants may receive a greater payout if they pursue compensation through the court process but the burden of proof will be greater in the court system than through the Redress Scheme.  However, the burden of engaging in the court process is likely to be more adversarial and stressful than the Redress Scheme. It’s challenging for survivors to provide the detailed particulars (time, date, location etc) often required for the court process, particularly if the child sexual abuse occurred many years ago and occurred multiple times.

The Redress Scheme is of significant benefit for the perpetrating institutions as payouts are likely to be less than through the legal process, and they won’t be tied up and financing legal processes for years.

A person should be eligible to apply to a redress scheme for redress if he or she was sexually abused as a child in an institutional context and the sexual abuse occurred, or the first incidence of the sexual abuse occurred, before the cut-off date.

That is unless you’re in prison.  If you are currently incarcerated you cant apply, you can do so when you’ve been released. If you’re out of gaol, but you’ve served more than a 5-year term then probably no redress for you, unless you are able to prove how rehabilitated you are.

Now I don’t want to get into an argument about prisoners getting money but here’s what infuriates me. The Royal Commission visited 60 prisons to take statements from prisoners who had been sexually abused in institutions.  They did this because there is such a clear understanding that child sexual abuse derails peoples lives to such an extent they are over-represented in the prison system.

I provided counselling to prisoners who had attended private sessions with the Royal Commission.  Their accounts of the sadistic child sexual abuse perpetrated against them were horrendous.  For some, the Royal Commission was the first time they had disclosed the abuse and the process of disclosing was traumatic.

Of the, 6,875 survivors and/or their family and friends who attended private sessions between May 2013 and May 2017 to share their experiences of child sexual abuse in Australian institutions, 713 (10.4 per cent) were in prison at the time of their private session.

On average, survivors in prison were aged 11.3 years when they were first sexually abused in an institutional context, though many said they experienced physical and sexual abuse prior to this, often within the family. The majority were sexually abused on multiple occasions (86.7 per cent). Most said they were sexually abused by a single person (53.7 per cent), and almost three-quarters for a duration of one year or less (71.5 per cent).

Royal Commission into Institutional Child Sexual Abuse: Final Report – Private Sessions

So the Redress Scheme seems to be saying to prisoners “thanks for telling us what happened to you, we know that it stuffed your life up, but too bad, no Redress for you or your family”.  Surely prisoners could apply and, if successful, any payout placed in trust.

Oh… and if you’re not an Australian citizen or permanent resident you also can’t apply.  So too bad if you came to Australia, went to school here, got sexually abused as a child at school and then went home!  No redress for you either.

A redress scheme should rely primarily on completion of a written application form.

Sounds easy, but filling out that 44-page document is complex.  Some survivors believed that their statement to the Royal Commission would have been sufficient as an application. It’s agonising to document a detailed account of child sexual abuse and then send it off to be assessed, by an unknown party. Once again survivors are placed in the role of having to prove what happened to them.

There are supports available to help people with the application process.  You can access them here: Redress Support Services.  I would encourage anyone completing the application to be supported by family, friends and/or the support services offered.

Counselling and psychological care should be supported through redress in accordance with the following principles:

  • Counselling and psychological care should be available throughout a survivor’s life.
  • Counselling and psychological care should be available on an episodic basis.
  • Survivors should be allowed flexibility and choice in relation to counselling and psychological care.
  • There should be no fixed limits on the counselling and psychological care provided to a survivor.
  • Without limiting survivor choice, counselling and psychological care should be provided by practitioners with appropriate capabilities to work with clients with complex trauma.
  • Treating practitioners should be required to conduct ongoing assessment and review to ensure treatment is necessary and effective. If those who fund counselling and psychological care through redress have concerns about services provided by a particular practitioner, they should negotiate a process of external review with that practitioner and the survivor. Any process of assessment and review should be designed to ensure it causes no harm to the survivor.
  • Counselling and psychological care should be provided to a survivor’s family members if necessary for the survivor’s treatment.

New South Wales, Victoria and the Australian Capital Territory have free counselling services as part of the redress offer.  Counselling services in Queensland, Tasmania, South Australia, the Northern Territory and Western Australia have not yet been finalised. Applicants living where States are not offering free counselling services will receive a payment of $5,000 to cover counselling.  That’s about 25 sessions throughout a lifetime.  That may not be sufficient to address complex trauma.

Some final thoughts….

We now have a situation where some child abuse survivors may feel abandoned by the Redress Scheme.  If you were in an institution and were viciously beaten and neglected, but not sexually abused you are now “unlucky” because you can’t access the Redress Scheme. The Royal Commission didn’t just uncover child sexual abuse, it also uncovered systemic physical and emotional abuse and neglect in institutions and yet these non sexually abused survivors have no access to the Redress Scheme.

I’m not sure the Redress Scheme sets right that which is morally wrong.

What are your thoughts regarding the Redress Scheme?

https://notforgotten.tv/2018/08/09/redress-the-setting-right-of-that-which-is-morally-wrong/

Childhood abuse never ended for thousands of Australian adults

PHOTO After surviving years of abuse at the hands of her family, Sarah has started a family of her own. ABC NEWS: TRACEY SHELTON

Sarah is living proof that “life after hell” is possible. 

For more than 20 years she says she endured beatings, rape and degradation at the hands of her family.

She tells of being locked in sheds, made to eat from a dog’s bowl and left tied to a tree naked and alone in the bush.

Her abusers spanned three generations and included her grandfather, father and some of her brothers. She has scars across her body.

“This is from a whipper snipper,” she says, pointing to a deep gouge of scar tissue wrapped around the back of her ankle. Higher up is another she says was caused by her father’s axe.


Family violence support services:


But Sarah survived.

Now she is speaking out in the hope of empowering others trapped in abusive situations. 

“There is life after hell, but you need to learn how to believe in yourself,” she says.

A reality for many Australian adults

As confronting as Sarah’s case may be, she is not alone. 

While most people assume child abuse ends at adulthood, it can bring control, fear and manipulation that can last a lifetime.

Incestuous abuse into adulthood affects roughly 1 in 700 Australians, according to research by psychiatrist Warwick Middleton — one of the world’s leading experts in trauma and dissociation. If that estimate is accurate, tens of thousands of Australian adults like Sarah are being abused by family members into their 20s or even up to their 50s.

PHOTO Warwick Middleton is one of the world’s leading experts in trauma and dissociation. ABCNEWS Tracey Shelton

“It’s a mechanism of ongoing conditioning that utilises every human’s innate attachment dynamics, and where fear and shame are used prominently to ensure silence — particularly shame,” says Professor Middleton, an academic at the University of Queensland and a former president of the International Society for the Study of Trauma & Dissociation.

He has personally identified almost 50 cases among his patients, yet there was no literature or studies on this kind of abuse when he began publishing his findings.

Hidden in ‘happy’ families, successful careers

Sydney criminologist Michael Salter has found similar patterns in his own research. He said cases of incest are “fairly likely” to continue into adulthood, but this extreme form of domestic abuse is unrecognised within our health and legal systems.

“It’s unlikely that these men are going to respect the age of consent,” says Mr Salter, who is an associate professor of criminology at Western Sydney University. “It doesn’t make sense that they would be saying, ‘Oh you’re 18 now so I’m not going to abuse you anymore’. We’re just not having a sensible conversation about it.”

The ABC spoke with 16 men and women who described being abused from childhood into adulthood.

They said their abusers included fathers, step-fathers, mothers, grandparents, siblings and uncles.

Medical and police reports, threatening messages and photos of the abuse supported these accounts. Some family members also confirmed their stories.

PHOTO Sarah’s father often recorded the abuse. This image is the first in a series of five she discovered in the family home.

Sarah says her father and his friends photographed some of her abuse. One image shows her beaten and bloodied with a broken sternum at five. In another photo (pictured here), she cowers as her father approaches with a clenched fist.

Most victims described their families as “well-respected” and outwardly “normal-looking”, yet for many the abuse continued well after their marriage and the birth of their own children, as they navigated successful careers. 

“You see a lot of upper-income women who are medical practitioners, barristers, physiatrists — high functioning in their day-to-day lives — being horrifically abused on the weekends by their family,” Mr Salter says.

Helen, a highly successful medical professional, says she hid sexual abuse by her father for decades.

“They didn’t see the struggle within,” she says. 

A mental ‘escape’

Professor Middleton describes abuse by a parent as “soul destroying”. In order to survive psychologically, a child will often dissociate from the abuse.

Compartmentalising memories and feelings can be an effective coping strategy for a child dependent on their abuser, says Pam Stavropoulos, head of research at the Blue Knot Foundation, a national organisation that works with the adult survivors of childhood trauma.

‘I learnt to disappear’

Like a “shattered glass”, three women discuss the myths and challenges of living with Dissociative Identity Disorder.

The extreme and long-lasting nature of ongoing abuse can result in dissociative identity disorder, which on the one hand can shield a victim from being fully aware of the extent of the abuse but can also leave them powerless to break away, Ms Stavropoulos says.

Claire*, 33, describes her dissociation as both her greatest ally and her worst enemy.

“You feel like you’ve keep it so secret that you’ve fooled the world and you’ve fooled yourself,” she says.

In her family, women — her mother and grandmother — have been the primary physical and sexual abusers and she says some of her abuse is ongoing.

“In a way you have freedom, but at the same time you are trapped in a nightmare,” she says.

‘It’s like he’s melted into my flesh’

For many, the attachment to an abuser can be so strong, they lose their own sense of identity.

Kitty, who was abused by her father for more than five decades until his recent death, says she did everything her family said to try to win their love.

“I thought I was some kind of monster because I still love my father,” she says. “It’s like he’s melted into my flesh. I can feel him. He is always here.”

Raquel’s rage grew from her family’s dark past

Four years into my relationship with my new partner, I realised I was continuing a cycle of abuse. I am a survivor of family sexual abuse who was raised by a child molesterer, and I was releasing my rage on the closest person to me, writes Raquel O’Brien.

Mr Salter says the conditioning is difficult to undo, and often leaves a victim vulnerable to “opportunistic abuse” and violent relationships.

“If the primary deep emotional bond that you forge is in the context of pain and fear then that is how you know that you matter,” he says. “It’s how you know that you are being seen by someone.”

Many of those the ABC spoke with were also abused by neighbours or within the church or school system. Others married violent men.

“They don’t have the boundaries that people normally develop,” Mr Salter says, adding that parental abuse could leave them “completely blind to obvious dodgy behaviour because that’s what’s normal for them”.

‘You believe they own your body’

Professor Middleton said premature exposure to sex confuses the mind and the body and leaves a child vulnerable to involuntary sexual responses that perpetrators will frequently manipulate to fuel a sense of shame, convincing them they “want” or “enjoy” the abuse.

For Emma*, violent sexual assaults and beatings at home began when she was five and are continuing more than 40 years later.

“When you are naked, beaten, humiliated and showing physical signs of arousal, it really messes with your head. It messes with your sexuality,” she says.

“Your sense of what is OK and what isn’t becomes really confused. You come to believe that they literally own you and own your body. That you don’t deserve better than this.”

A medical report viewed by ABC shows Emma required a blood transfusion last month after sustaining significant internal tissue damage from a sharp object. The report stated Emma had a history of “multiple similar assaults”.

She said medical staff do want you to get help and sometimes offered to call police.

“What they don’t understand is that for me police are not necessarily a safe option,” she says.

As a teenager she had tried to report to the police, but was sent back home to face the consequences.

She said a “lack of understanding about the dynamics of abuse and the effects of trauma” mean victims rarely get the response and help they need.

While Emma has been unable to escape the abuse, she has made many sacrifices to shelter her children from it. But they still suffer emotionally, she says.

“It makes it hard for anyone who cares about you having to watch you hurt over and over again.”

Incest after marriage and kids

For Graham, it was devastating to find out his wife Cheryl* was being sexually abused by both her parents 10 years into their marriage.

“I had no idea it was going on,” he says, of the abuse that continued even after the birth of their children. “The fight between wanting to kill [her father] and knowing it’s wrong wasn’t fun. I don’t think people know what stress is unless they’ve been faced with something like that.”

With Graham’s support, the family cut contact with his in-laws. He says the fallout of this abuse ripples through society impacting everyone around both the abused and the abuser.

Mr Salter urges anyone suffering abuse to reach out for help, and for those around them to be supportive and non-judgemental.

“You can get out — don’t take no for an answer. Keep fighting until you find someone who is going to help you keep fighting,” he says.

A new life

Sarah met Professor Middleton after a suicide attempt at 14, but it took many years for her to trust and accept that things could change.

“I just couldn’t grasp I was free. It didn’t matter what anyone did,” she says. 

“I still felt overall that my family was in control of me and at any moment they could kill me.”

Through therapy with Professor Middleton — who she spoke of as the only father figure she has ever known — and the support of her friends and partner, Sarah finally broke away from her abusive family to start a new life of her own.

“You need people to help you through it. In the same way that it took other people to cause you the pain, it takes new people to replace them and help you give yourself another go,” she says.

“If I can give hope to one other person out there, then all my years of pain will not have been for nothing.”

*name changed to protect identity

https://mobile.abc.net.au/news/2018-09-01/family-sex-abuse-survivor-took-rage-out-on-partner/10155992

Long term effects of child sexual abuse (2)

Early Research

The manner in which the long-term effects of child sexual abuse have come to be conceptualised reflects, in no small measure, the very particular circumstances that surrounded the revelation of child sexual abuse as an all too common event in the lives of our children. The first phase of modern research into child sexual abuse was not triggered by observations on child victims, but by the self-disclosures of adults who had the courage to publicly give witness to their abuse as children. These early self-revealed victims, exclusively women, had often been the victims of incestuous abuse of the grossest kind, and plausibly attributed many of their current personal difficulties to their sexual abuse as children. This contrasts with the emergence of child abuse as a public health and research issue that has been driven by the observations of professionals caring for abused children.

Implications

The way child sexual abuse was placed on the public and health agendas put a stronger emphasis on the adult consequences of abuse than on the immediate implications for an abused child. It also emphasised the psychiatric implications of abuse because self-declared victims tended to focus on these, and these revelations often occurred in a broadly therapeutic context with mental health professionals. Early research into the effects of child sexual abuse frequently employed groups of adult psychiatric patients (Carmen et al. 1984; Mills et al. 1984; Bryer et al. 1987; Jacobson and Richardson 1987; Craine et al. 1988; Oppenheimer et al. 1985) which further reinforced the emergence of an adult-focused psychiatric discourse about child sexual abuse. It should also be noted that the manner in which child sexual abuse was rediscovered (for it had been well recognised in the 19th century) and the nature of the advocacy movement which placed child sexual abuse firmly on the social agenda also provided an almost exclusive emphasis on female victims and incestuous abuse. The implications remain largely unexplored of the abuse of boys (which for abuse of the most intrusive kinds involving penetration rivals in frequency that of girls), and of the fact that the majority of abuse is not incestuous.

https://royalcommbbc.blog/2018/12/21/long-term-effects-of-child-sexual-abuse/

Long-term Effects of Child Sexual Abuse

Child sexual abuse is widely regarded as a cause of mental health problems in adult life. This article examines the impact of child sexual abuse on social, sexual and interpersonal functioning, and its potential role in mediating the more widely recognised impacts on mental health. In discussing the relationship between child sexual abuse and adult psychopathology, the authors evaluate a number of models, including the post-traumatic stress disorder model, the traumatogenic model, and developmental and social models. They look at family risk factors which predispose children from specific population groups to be at greater risk of abuse, and conclude that the fundamental damage caused by child sexual abuse impacts on the child’s developing capacities for trust, intimacy, agency and sexuality.

In little over a decade, child sexual abuse has come to be widely regarded as a cause of mental health problems in adult life. The influences of child sexual abuse on interpersonal, social and sexual functioning in adult life and its possible role in mediating some, if not all, of the deleterious effects on mental health, has attracted less attention and research, but is arguably equally important. For this reason, and because the mental health aspects have been so much more widely canvassed and ably reviewed (Tomison 1996), this review will emphasise the impact of child sexual abuse on social and interpersonal functioning, and its potential role in mediating the more widely recognised impacts on mental health.

Long-term Effects of Child Sexual Abuse 
by Paul E. Mullen and Jillian Fleming
www.aifs.gov